Psychoanalysis

Literary quotations and time-worn stereotypes exert a deplorable influence on our thinking. They lead us to consider certain open questions as settled, certain puzzling problems as solved.

From time immemorial, the unthinking and thinking alike, have accepted the idea of a kinship between sleep and death. Expressions like "eternal sleep" show by the frequency with which they recur, how constantly associated the two ideas are in the average mind.

Not only is that association absurd but its consequences are regrettable, at least from one point of view: if sleep is a form of death, the psychic phenomena connected with it are bound to be misinterpreted and either granted a dignity they do not deserve or scornfully ignored.

The superstitious may loose all critical sense and see in sleep and sleep thinking something mysterious and mystical. The scientist, on the other hand, may consider such phenomena as beneath his notice.

No sober appreciation of sleep and dreams can be expected from any one who associates in any way the idea of sleep and the idea of death.

Respiration seems to be the essential feature of life, and its lack, the essential feature of death. As long as respiration takes place, the two ferments of the body, pepsin and trypsin, break up insoluble food molecules into soluble acid molecules which are then absorbed by the blood and carried to the cells of the body where they are utilized to build up new solid cell matter.

When respiration ceases, a degree of acidity is reached which enables the two ferments to digest the body of disintegrating each cell. This is according to Jacques Loeb the meaning of death.

No such chemical action is observable in any form of sleep.

From that point of view, sleep is a form of life.

Sleep is even a more normal form of life than the average waking states.

In the normal waking states, the vagotonic nerves of the autonomic system which upbuild the body and insure the continuance of the race should dominate the organism, being checked in emergencies only by the sympathetic nerves which constitute the human safety system.

The vagotonic nerves contract the pupil, make saliva and gastric juice flow, slow down the heart beats, decrease the blood pressure, promote sexual activities, etc.

The sympathetic nerves on the contrary, dilate the pupil, dry the mouth, stop the gastric activities, increase the heart beats, raise the blood pressure, decrease or arrest the sexual activities, etc.

In peaceful sleep, we observe that the vagotonic functions hold full sway. In sleep, our pupils are contracted. Even when they have been dilated by atropine, they become contracted again in sleep.

In sleep, the digestive organs continue to perform their specific work, all the popular beliefs to the contrary notwithstanding. Infants and animals generally go to sleep as soon as they finish feeding. Animals digest infinitely better if allowed to sleep after being fed, than if compelled to stay awake, walk or run.

The activity of the sexual organs is as great in sleep as in waking life; in certain cases, it is even greater.

At certain times, during sleep, the pressure of the blood in the brain is greatly reduced, and certain authors have concluded that sleep was characterized by brain anaemia, which some of them consider as the cause of sleep.

Indeed, unconsciousness can be induced by producing a temporary brain anaemia, for instance by compressing the carotid arteries of the neck for a minute or so. Sleepiness almost always appears then and lasts as long as the pressure is exerted.

Special manometers show that the fall in the blood pressure invariably precedes the appearance of sleep. In dogs whose skulls have been trephined for purposes of observation, the brain can be seen to turn pale as soon as the animals fall asleep.

But we have here simply one of the vagotonic activities mentioned previously. In the normal organism, the blood pressure should be low, rising only in emergencies, when the organism is facing some danger and must be prepared for fight or flight.

And in fact, the slightest light, noise, pain or smell stimulus, is sufficient to bring the blood back to the brain during sleep. Our sympathetic nerves are on the watch and even if the subject does not wake up, they rush the blood whenever it is needed for emergency action, in this case, to the general switchboard of the organism, the brain.

But this so-called brain anaemia is not constant during the entire period of sleep. The pressure falls gradually before sleep sets in and only reaches its minimum an hour after sleep has begun. Then it increases gradually and becomes normal again about the usual waking time. We shall see later that attention follows an identical curve.

It has been pointed out that in sleep the respiration becomes slower and that the amount of air inspired and consequently of oxygen assimilated is lowered. But inaction in the waking states will show exactly the same results.

A smaller quantity of carbonic acid is eliminated in sleep, the decrease being about sixteen per cent. But that condition is not due to sleep. It is due to many other factors such as the absence of light, etc.

The nature of the food taken before retiring has also a notable influence on the quantity of carbonic acid eliminated by the sleeper; the quantity varies from seventy five per cent after a meat supper to ninety per cent after a diet of starches.

The sweat glands of the skin secrete more actively in sleep than in waking life, which is also a vagotonic symptom and is also due to the fact that the sweat centre is easily affected by carbonic acid.

This increase in the activity of the skin accounts for the decrease we notice in the activity of the kidneys. (More urine is produced on cold days when the perspiration is scanty than on hot summer days.)

The lowering of the temperature in sleep is simply a result of inactivity, not of sleep.

We know that many pains, especially neuralgias, disappear in sleep. Many of those ailments, however, are of a neurotic origin and constitute a form of escape from reality. When reality has been practically abolished by unconsciousness, they are no longer "needed."

Experiments made on instructors of the University of Iowa who were kept awake for ninety hours showed that the weight of the subjects increased during the experiments, decreasing later when the subjects were allowed to resume their natural life and to sleep. The increase was solely due to the fact that during the experiments, the subjects were relieved of their duties, remained idle in the psychological laboratory and hence consumed less organic matter than if they had led an active life, preparing their courses and teaching several hours a day.

It has been stated many times that a form of motor paralysis sets in during sleep. Yet we all know of the many motions performed by every sleeper, turning from side to side, drawing or pushing away the bed clothes, removing stimuli applied to the face, talking, not to mention, of course, sleep walking.

Sleep does not even mean complete muscular relaxation, for sentinels have been observed who could sleep standing; some people sleep sitting up in their chairs. Many animals, birds, bats, horses, sleep in positions which make muscular relaxation impossible; when their balance is disturbed by an observer, they re-establish it without awaking. Sleeping ducks keep on paddling in circles to avoid drifting against dangerous shores, etc.

In other words, there is not a part of our body which ceases in sleep to perform its specific work. Our lungs continue to breathe, our heart to send blood to all parts of the body, our glands secrete various chemicals; we hear, smell and to a certain extent, see. The lowering of our eyelids is simply a half-conscious effort to remove sight stimuli. Our nails and hair continue to grow, although, for that matter, they do so for some time even after death.

Finally our mental activity does not cease during sleep. Wake up a sleeper at any time and he will awaken from a dream. He may not be able to tell that dream but he will know for sure that, not only was he dreaming, but had been dreaming for a long while before awaking.

Wherein, then, does sleep differ from waking life?

Solely in the form of our mental activities.

Sleep is not as Manacéine, the author of the most complete book on sleep, stated: the resting time of consciousness. We do not withdraw our attention completely from the environment in sleep.

When we make up our minds, for instance, to wake up at a certain time, we seldom fail to carry out our purpose. Which does not mean that we are suddenly aroused out of our unconsciousness by something within ourselves, but more probably that our attention has been concentrated all night on certain stimuli indicating time, distant chimes, activities taking place at a definite hour, and which we had noticed unconsciously, although they may have escaped our conscious attention. It has even been suggested that as respiration and pulse are more or less constant in rest, they are used by the organism as unconscious time-registers. This is possibly one of the phenomena due to the activity of the pituitary body in which may reside the "sense of time" and which controls all the rhythms of the body.

Jouffroy, Manacéine and Kempf have remarked that nursing mothers may sleep soundly in spite of the disturbances which take place about them, but that the slightest motion of their infant will awaken them. Many nurses not only can wake up at regular intervals to administer a drug to their patients, but, besides, can be aroused out of a sound sleep by a change in the patient's breathing foreboding some danger.

Our withdrawal of attention from reality follows the same curve as that followed by the withdrawal of blood from the brain.

Many experiments have been made to determine that curve and to sound the depth of sleep. In one case a metallic ball was allowed to fall from varying heights until the noise awakened the sleeper; in another case electric currents of varying voltage were used to stimulate the subject, etc. All experiments have yielded the same results: Sleep reaches its lowest depth during the first two or three hours, the average time being shorter during the day than at night. In the majority of subjects, the greatest depth is reached about the end of the first hour. After the third hour, sleep is easily disturbed, the more so as the usual awakening time approaches.

To conclude, we will say that sleep partakes of all the characteristics of normal life, the only essential difference we can establish scientifically being a greater withdrawal of attention from reality in normal sleep than in normal waking life.

We insist on using the terms normal waking life, for there are forms of abnormal waking life in which attention is withdrawn as completely from reality as it is in normal sleep.

In the disease designated by psychiatrists as dementia praecox, the patient may become entirely negative, some time regressing to the level of the unborn child, and withdraw even more entirely from reality than the sleeper who, without awaking, is conscious of certain stimuli and performs certain actions showing a comprehension of their nature.

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What causes sleep? What causes us to withdraw partly our attention from our environment? The answer: brain anaemia, is unsatisfactory for we may ask in turn: what causes brain anaemia?

A study of brain anaemia leads one to conclude that it coincides with the usual sleeping period and that it is produced by sleep instead of producing sleep.

The large majority of laymen and scientists, however, give a much simpler answer: we go to sleep because we are tired and need rest.

Even as sleep and death have been coupled in the literature of all nations, fatigue and sleepiness, rest and sleep have come to be generally considered as synonymous.

Fatigue, however, is as difficult to define scientifically as sleep. Drawing a line between physical fatigue and mental fatigue does not simplify the problem; on the contrary, it complicates it by positing it wrongly.

We know that there is no purely physical fatigue. Fatigue is only caused in a very restricted measure by the accumulation of "fatigue" products or the depletion of repair stocks.

Under certain "mental" influences, our muscles can perform much more than their usual "stint" without showing fatigue. Hypnotize a man and he will do things he could not attempt in the waking state. He can lie rigid, reposing on nothing but his neck and heels; he can even support in that position the weight of a full-sized man. Men on the march can show wonderful endurance provided their "spirits" are kept up by some form of cheer, band music, etc. Ergograph observations show that signs of muscular fatigue appear and disappear without any obvious "physical" reason. Standardized motions which have been made almost automatic, tire us less than conscious activity.

We shall not deny that in certain cases fatigue may appear purely "physical." When a continued expenditure of energy, walking, carrying heavy burdens, has induced muscular soreness, the organism must cease exerting itself for a while and recuperate.

But relatively few people perform physical activities which actually wear out the organism.

Even then, if that form of exhaustion was conducive to sleep, the more complete the exhaustion was, the deeper the sleep should be.

Yet we know that people can be "too tired to sleep."

This is easily explained through a consideration of a phenomenon known as the "second wind" and which, before Cannon's observations on the chemistry of the emotions, was rather mysterious.

Athletes competing on the running track are often seen to falter and fall back, apparently exhausted; after which, they suddenly seem to breathe more freely, they overcome their limpness and start out on a fresh spurt which may cause them to head off steadier runners.

What happens in such a case is this: great physical exertion causes a form of asphyxiation. Asphyxiation and the concomitant fear, liberate adrenin which restores the tone of tired muscles and also glycogen (sugar) which supplies the body with new fuel.

If the exertion continues long enough to use up all these emergency chemicals, the muscular relaxation necessary for sleep may be obtained. Otherwise, the organism prepared for a struggle with reality, will not lend itself to a flight from it. Although we are "worn out" we toss about in our bed, try all possible sleeping positions and only sleep when the energy which was supplied for a long struggle has been entirely burnt up.

The majority of people, after all, busy themselves with tasks which do not really deplete their stores of energy, but which prove monotonous. That monotony is then interpreted as fatigue.

In such cases, rest seems to be more easily attained through a change of activity than through mere cessation of activity.

A business man has been closeted in his office attending to many tedious details, reading letters and answering them, etc., and by five o'clock he feels "tired." He will then go home, change his day suit for evening wear, attend a dinner at which he will do perhaps much talking, then watch actors for three hours and feel "rested."

Or at the end of a "heavy" week, he will gather up his golf outfit and walk miles in the wake of a rubber ball. He returns to his work "rested," although he has only exchanged one form of activity for other forms of activity. Of actual "rest" he has had none.

Children "tired" of sitting in a class room will romp wildly, shout at the tops of their lungs, jostle and fight one another and return to meet their teacher "rested."

Undirected activity in the young, pleasurable activity in the adult do not seem to make rest necessary, and in fact are a form of "rest."

Egotistical gratification easily takes the place of rest. Heads of large businesses have sometimes mentioned to me that they worked much harder than some of their employés. Some of them kept on revolving commercial schemes in their heads or attending business meetings long after their office workers had left. "And yet," they added, "we are not complaining about being tired." Nor were they as tired, after fifteen hours of "free labor" as their employés were after six or eight hours of routine work allowing them very little initiative and independence of action.

Edison works eighteen hours a day and only "rests" through sleep some four hours out of the twenty four. I wager that if he were put at work in his own plant, under the direction of a foreman, performing regular, monotonous tasks, he would break down under the strain of such long hours and would have to "rest" twice as much as he does now. His work satisfies him, and every new detail he perfects, every novelty he initiates, vouchsafes him a powerful ego gratification.

Napoleon, too, could perform incredible feats of muscular activity and endurance after which four hours' sleep were sufficient to rest him. His life was for many years a continuous round of ego gratifications, won at the cost of great exertions, it is true, but proclaiming to him and the world his almost unrestricted power and luck.

One is forced to the conclusion that a desire for rest is a desire, not for decreased activity but for increased activity.

I shall make this point clear through a simile. The manufacturer who "attends to business" must, in order to succeed, "concentrate" on a few subjects and exclude all others from his mind. He may for a few hours think of nothing but, let us say, a certain grade of woollens, certain machinery, a certain customer and perhaps a certain engineer and some financial problem connected with those four thoughts. He must therefore exclude from his mind at the time, thoughts of playing golf, buying new clothes, going to the theatre, renting an apartment, repairing his motor car, thoughts of meals, women, card playing, and many other thoughts which are clamouring for admission to consciousness because they all represent human cravings.

In his relaxed moments he will let all those other thoughts come to the surface. Which means that, what tired him, was the fact that he had to keep all those subjects down and allow only the other four to rise to consciousness.

Mental rest consists in admitting ideas pell mell into consciousness without exercising any censorship on them. It consists in passing from a reduced but directed mental activity to an increased but undirected mental activity.

In other words, rest is the free, normal, unimpeded functioning of the vagotonic nerves which upbuild the body and assure the continuance of the race. Ego and sex activities, mental and physical, are constantly struggling for admission to consciousness and for their gratification. They are held down, however, by the sympathetic nerves which play the part of a safety device, moderating or inhibiting the vagotonic activities whenever the latter might endanger the personality.

Physical and mental rest, however, being easily attained through a change of activities, cannot be entirely synonymous with sleep. Sleep takes place mainly while we are resting, although we know of cases when sleep sets in regardless of continued muscular activity, but sleep is not exactly "rest." We do not sleep because we need rest. In many cases we can or could rest very well, although in such cases sleep is an impossibility.

What then induces sleep? The certainty that we can for a time relax our watch on our environment; a feeling of perfect safety; the conscious or unconscious knowledge that no danger threatens us.

Our receptive contact with reality is attained through the action of our vagotonic nerves which, as stated before, upbuild the body and assure the continuance of the race. Our defensive contact, on the other hand is attained through our sympathetic nerves which interrupt all the activities which are not necessary for fight or flight. As long as some stimulus is interpreted by those nerves as indicating a possible danger, we cannot sleep, although we may, under the influence of terrifying fear, fall into unconsciousness.

A light flashed on our closed lids at night causes us to wake up because sympathetic activities bid us to prepare for an emergency. A light burning evenly in our bedroom and not too bright to cause physical pain, will, on the other hand, allow us to sleep soundly because the constant character of the stimulus does not cause us to expect any danger therefrom.

A mouse rustling a bit of paper will wake us up, but trains passing in front of our window at regular intervals, or the constant rumble of a neighbouring power house will not prove a disturbance as soon as our nerves have learnt to interpret those stimuli as harmless.

Conversation with a dull, witless person, unlikely to best us in debate, puts us to sleep. Argument with keen, sharp-minded people, who keep us on the defensive, may lead to sleeplessness for the rest of the night. A dull book in which nothing happens or is expected to happen, acts as a soporific; we cannot close our eyes before we know the dénouement of a thrilling piece of fiction.

In other words, monotony transforms itself into a symbol of safety. Safety does not require the muscular tension, the blood stream speed which the organism needs in order to cope with possible emergencies. We "let go" and no longer pay any close attention to our environment. We sleep.

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Monotony symbolizing safety enables us to withdraw our attention from our environment, from a reality which we no longer fear, but it does not compel us to do so. There is in sleep a certain amount of compulsion which is not accounted for by the mere monotony of environmental stimuli. We go to sleep willingly but not entirely of our own free will. We yield to sleep.

A consideration of abnormal sleep states will help us considerably in determining the actual cause of sleep.

Abnormal states always throw a flood of light on normal states of which they are only an exaggerated variety. The neurosis is the best magnifying glass through which to watch normal life, provided of course that we afterward reduce our observations to the proper scale.

The average person sleeps from six to ten hours out of the twenty four, some time between eight at night and ten in the morning. In abnormal cases, on the other hand, we see the duration of sleep considerably prolonged and the onset of sleepiness appearing at times when complete wakefulness is usually the rule.

The circumstances surrounding those abnormal cases are never pleasant. We never hear of any one falling asleep while witnessing a very amusing play, while in the company of a very interesting person or while busy with some extremely attractive occupation.

One incident from Napoleon's biography will make my meaning clear. During his days of glory Napoleon never slept more than four or five hours out of the twenty four. His physical and intellectual activities were prodigious. He would, at times, ride on horseback for ten hours at a stretch, then hold conferences with his staff until late into the night, then dictate innumerable letters. Yet he did not feel tired or sleepy and a few hours of sleep were sufficient to "relieve his fatigue."

On the other hand, let us remember what happened after the battle of Aspern, the first he lost after a series of seventeen victories: He fell asleep after a long, unsuccessful struggle with drowsiness and for thirty-six hours could not be aroused.

His biographers also mention that when his life dream was shattered at Waterloo and he was sent into exile on a remote island, he began to sleep as many hours as the average, normal man.

After Aspern and after Waterloo, reality had become such, that an escape from it, via the unconsciousness of sleep, must have been welcome. That the reaction of defeat must have been more keenly felt by the young man who lost Aspern and who presented strong neurotic traits, than by the more settled man who lost Waterloo, can be easily understood.

Nansen in his Polar exile slept twenty hours a day. He certainly was not in need of rest or recuperation, for his idleness was complete, but the reality of ice and snow which kept him a prisoner, was one from which he was glad to withdraw his attention.

I personally observed two cases in which sudden fits of sleepiness could be interpreted as an escape from reality.

A gambler could go for several days and nights without sleep, provided he was winning. After a heavy loss or a period during which his earnings were offset by his losses, he would go to bed and sleep as much as four days and four nights at a time, arising once or twice a day to partake of some food and returning at once to his slumbers.

A neurotic with a strong inferiority complex was overwhelmed by sleepiness every time he encountered a defeat of a sexual or egotistic nature. After a quarrel, or whenever a discussion in which he took part turned to his disadvantage, he had to lie down and "sleep it off."

This is probably the key to the enigma of Casper Hauser's case. He was born in Germany at the beginning of the last century and brought up in complete solitude, in a small dark room. At the age of seventeen, he had never seen men, animals or plants, the sun, moon or stars. He then was taken out of his cell, and abandoned on the streets of Nuremberg, dazed and helpless.

All the efforts made by kind Samaritans to develop his mentality proved futile. They had only one result: to make him fall asleep. Accustomed for years to the peace, quiet and safety of his cell, he reacted to a new, troublesome and complicated environment as newly born infants do, who in incredibly long periods of sleep, in no wise explainable through fatigue, escape reality and return to the perfect happiness of the fetal state.

In certain forms of the disturbance known as sleeping sickness, people merge into a sleep which continues for weeks, months or even years, and which sometimes culminates in death. (In many cases, however, the sleepiness may be totally lacking.)

The sleeping sickness was first observed some hundred years ago on the West Coast of Africa and, since then, in an area of the African continent extending from Senegal to the Congo. Negroes are almost the only sufferers, although a few whites have been affected by this disease which, at times, extends to large numbers of the population.

According to various medical observers, the sleeping sickness usually appears among slaves doing arduous, exhausting work.

It is the individuals who stand lowest in intelligence who are most severely affected. In communities where the mental development has been retarded, imitation easily spreads the contagion and this is probably the reason why entire villages are decimated by that curious malady.

Whether the sleeping sickness is in certain cases induced by the bite of a fly or appears without obvious physical cause is immaterial.[1] Paranoia induced by syphilis is in no way different from ordinary paranoia.

Hence we are justified in linking together certain aspects of the African sleeping sickness and the lethargic ailment which affects the white races in Europe and America.

Both have the appearance of normal sleep, the only striking difference, barring certain physical syndromes, being the unusual length of the sleeping period or its onset at unusual and unexpected times.

In white subjects, narcolepsy is seldom fatal but has been known to last for years.

The most famous case on record is probably that of Karoline Ollson reported in a Salpétrière publication for 1912.

Karoline Ollson was born in 1861 in a small town of Sweden. At the age of 14, at the onset of her menstruation, she once came home complaining of toothache, went to bed and remained bedridden till 1908. For thirty-two years she slept all day and all night, waking up now and then for a few minutes, taking dim notice of happenings in her environment and speaking a few words. Two glasses of milk a day seemed to be sufficient to sustain her. She was kept for a fortnight in a hospital from which she was discharged when her ailment was diagnosed as "hysteria."

When her mother died in 1905 she woke up and wept as long as the corpse remained in the house. Then she became quiet again and resumed her slumbers. In April, 1908, when her menstruation stopped, she woke up, left her bed and has led a normal life since.

Dr. Toedenstr?m who describes the case states that she looked incredibly young. Two weeks after she left her bed she had become strong enough to take charge of the household.

Stekel, discussing this strange case in one of his lectures, said: "This woman spent the entire time of her womanhood in sleep, for she fell asleep at the time of her first menstruation period and her awakening coincided with her climacteric. She was a child and wished to remain a child. The first question she asked on arising, 'Where is mama?' shows that she was suffering from psychic infantilism. It is probable that dreams of childhood filled her thirty-year sleep and she may even have dreamt that she was still an unborn child for whom life had not yet begun."

Medical literature contains many reports of freakish cases in which the subject falls asleep suddenly, while attending to duties of an uninteresting character; a young waiter, for instance, falling asleep while waiting on a table, remaining absolutely motionless for a whole minute and then waking up and resuming his work. Manacéine mentions two similar cases she observed personally. Both patients were illiterate and of slow intellect. One of them, a housemaid of nineteen, was a sound sleeper at night and yet, in the day time, one could never be sure of her remaining awake. She fell asleep once in the act of announcing a visitor and while bringing in a tray loaded with cups of coffee. The other was a woman of fifty, who was employed as a nurse until one day, falling asleep suddenly, she dropped an infant on the floor and almost killed him. In both the pulse was remarkably slow (a vagotonic symptom): in the girl it varied from 50 to 70 when awake, in the older woman from 40 to 60.

An epidemic of sleeping fits, lasting only a few minutes at a time, raged for several years in a small German town near Würzburg. The attacks took place at any moment and were liable to leave the patient immobilized in some curious position. It was the weaker part of the population, physically and mentally, which was affected by that curious trouble, apparently transmitted from parents to children, probably, as all neurotic complaints are, through imitation.

Stekel considers hysterical and epileptic fits as forms of morbid sleep during which hysterics gratify sexual cravings and epileptics sadistic cravings.

This is how Dr. Isador Abrahamson describes, from recent cases observed at Mount Sinai Hospital, the course of lethargic encephalitis which is one of the scientific names coined to designate the sleeping sickness:

"At the onset of the disease, there is a period of variable duration in which the patient experiences increasing difficulty in attending to his work. Next a time of yawning ensues, in which there may be also the irritability of the overtired. Then the eyes close, chiefly from lack of interest.... (The patient's) pulse, temperature, and respiration may all be of a normal character.... From the depth of this seeming slumber, he may respond immediately when questioned and his short but coherent answers show no loss either of memory or of orientation.... His answer given, he straightway resumes his seeming sleep.... His attitude expresses a desire to be let alone, a desire which is sometimes articulate in him.... The somnolence may deepen into a stupor from which the patient is not easily aroused to conscious repose.... In the night watches ... a restless delirium of inconstant severity often appears. Spontaneous movements and sounds are made. The movements are purposeful graspings and pointings at unseen things, tossings and turnings...."

The author adds in another part of his article that "The depth of the somnolence and also its duration are unrelated to the severity of the cerebral lesions.... The extent of the mental disturbance bears no correspondence to the extent of the lesions, the amount of fever or the blood picture...." [Italics mine.]

We have a perfect picture of a flight from reality into a somnolence into which the unconscious complexes force at times a terrifying presentation of the dreaded reality through nightmares.

The few cases of sleeping sickness reported in recent medical literature show a decided neurotic trend in the subjects affected and reveal circumstances in the patient's life which would make a flight from reality highly desirable.

One typical case reported to me by a Boston physician who personally considers the sleeping sickness as being "unquestionably an acute organic disease of the cerebro-spinal system" has all the earmarks of a neurotic affection:

"The patient, a middle aged woman lost a child she loved dearly one year and a half before the onset of the disease. The circumstances of the child's death were particularly sad as the mother was not allowed to visit the little sufferer at the hospital on account of the contagious character of his disease. She also felt disturbing doubts as to the competence of the first physician who attended her child.

"She had been 'nervous and run down' since the child's death. She is married to a cripple twenty years her senior. She had to go to work in order to help support the household and to live with relatives of her husband's who did not contribute to the pleasantness of her home life."

Have we not here all the environmental conditions which would drive a neurotic to withdraw his attention from reality through a protracted period of sleep?

From the fact that I have instituted a comparison between sleep and the sleeping sickness, the reader should not draw the conclusion that I attribute to sleep any neurotic character.

Sleep is a compromise, as I shall show later, when discussing dream life, between what the human animal was meant to do and what it can do in reality.

The neurosis, also is a compromise, but it is a compromise that fails, while sleep is a compromise which is successful, beneficial and acceptable to all.

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